Swarup Ray, Uditi Parmar, Raylene Dias, Vishal Saxen, Fatema Mujpurwala, K A Anu
{"title":"超声测量视神经鞘直径在腹腔镜手术中的儿科患者:一项观察性研究。","authors":"Swarup Ray, Uditi Parmar, Raylene Dias, Vishal Saxen, Fatema Mujpurwala, K A Anu","doi":"10.4103/joacp.joacp_77_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Laparoscopic surgery involves creation of carbondioxide (CO<sub>2</sub>) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed to study the magnitude of changes in ONSD occurring during pediatric laparoscopic surgery and correlate them with changes in end-tidal CO<sub>2</sub> (EtCO<sub>2</sub>), intrabdominal pressure (IAP), and a change in patient position (P).</p><p><strong>Material and methods: </strong>Thirty-five pediatric patients between 1 and 12 years undergoing laparoscopic surgeries under general anesthesia were included.The ONSD, EtCO<sub>2</sub>, IAP, and position (P) in degrees from supine were recorded 15 min post-anesthesia induction(T1) and 30 min following the establishment of pneumoperitoneum (T2).The difference between the two groups was analyzed using a paired or unpaired <i>t</i>-test for quantitative variables and using Chi-square or Fisher's exact test for qualitative data.Correlation between two quantitative variables was performed using Pearson's correlation coefficient.</p><p><strong>Results: </strong>Mean ONSD showed a significant change (<i>P</i> < 0.001) 30 min (T2) following pneumoperitoneum increasing by an average of 0.04cm as compared to 15 min (T1) post-anesthesia induction (0.57 ± 0.06 vs. 0.61 ± 0.06). There was a moderate to strong positive correlation between change in ONSD and change in EtCO<sub>2</sub>(correlation coefficient = 0.629, <i>P</i> = 0.001) 30 min post pneumoperitoneum. There was a weak correlation between change in ONSD and change in position (correlation coefficient = 0.276) and a very weak correlation between change in ONSD and change in IAP (correlation coefficient = 0.19).</p><p><strong>Conclusions: </strong>Laparoscopic surgeries in children can cause significant increases in ICP as measured by the ONSD; changes in EtCO<sub>2</sub> are the predominant factor responsible. Increasing minute ventilation to maintain normal EtCO<sub>2</sub> may help mitigate changes in ICP in children undergoing laparoscopic surgery.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"298-303"},"PeriodicalIF":1.1000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002696/pdf/","citationCount":"0","resultStr":"{\"title\":\"Ultrasonographic measurement of optic nerve sheath diameter during laparoscopic surgeries in pediatric patients: An observational study.\",\"authors\":\"Swarup Ray, Uditi Parmar, Raylene Dias, Vishal Saxen, Fatema Mujpurwala, K A Anu\",\"doi\":\"10.4103/joacp.joacp_77_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Laparoscopic surgery involves creation of carbondioxide (CO<sub>2</sub>) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed to study the magnitude of changes in ONSD occurring during pediatric laparoscopic surgery and correlate them with changes in end-tidal CO<sub>2</sub> (EtCO<sub>2</sub>), intrabdominal pressure (IAP), and a change in patient position (P).</p><p><strong>Material and methods: </strong>Thirty-five pediatric patients between 1 and 12 years undergoing laparoscopic surgeries under general anesthesia were included.The ONSD, EtCO<sub>2</sub>, IAP, and position (P) in degrees from supine were recorded 15 min post-anesthesia induction(T1) and 30 min following the establishment of pneumoperitoneum (T2).The difference between the two groups was analyzed using a paired or unpaired <i>t</i>-test for quantitative variables and using Chi-square or Fisher's exact test for qualitative data.Correlation between two quantitative variables was performed using Pearson's correlation coefficient.</p><p><strong>Results: </strong>Mean ONSD showed a significant change (<i>P</i> < 0.001) 30 min (T2) following pneumoperitoneum increasing by an average of 0.04cm as compared to 15 min (T1) post-anesthesia induction (0.57 ± 0.06 vs. 0.61 ± 0.06). There was a moderate to strong positive correlation between change in ONSD and change in EtCO<sub>2</sub>(correlation coefficient = 0.629, <i>P</i> = 0.001) 30 min post pneumoperitoneum. There was a weak correlation between change in ONSD and change in position (correlation coefficient = 0.276) and a very weak correlation between change in ONSD and change in IAP (correlation coefficient = 0.19).</p><p><strong>Conclusions: </strong>Laparoscopic surgeries in children can cause significant increases in ICP as measured by the ONSD; changes in EtCO<sub>2</sub> are the predominant factor responsible. Increasing minute ventilation to maintain normal EtCO<sub>2</sub> may help mitigate changes in ICP in children undergoing laparoscopic surgery.</p>\",\"PeriodicalId\":14946,\"journal\":{\"name\":\"Journal of Anaesthesiology, Clinical Pharmacology\",\"volume\":\"41 2\",\"pages\":\"298-303\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002696/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Anaesthesiology, Clinical Pharmacology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/joacp.joacp_77_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/16 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anaesthesiology, Clinical Pharmacology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/joacp.joacp_77_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/16 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的:腹腔镜手术涉及二氧化碳(CO2)气腹的产生,导致颅内压(ICP)升高,这可能导致视神经鞘直径(ONSD)的扩张。我们的目的是研究小儿腹腔镜手术中ONSD的变化幅度,并将其与末潮CO2 (EtCO2)、腹内压(IAP)和患者体位(P)的变化联系起来。材料和方法:纳入35例1 ~ 12岁的全麻下腹腔镜手术患儿。麻醉诱导后15分钟(T1)和气腹建立后30分钟(T2)分别记录ONSD、EtCO2、IAP和仰卧度体位(P)。两组间的差异对定量变量采用配对或非配对t检验,对定性数据采用卡方或费雪精确检验。两个定量变量之间的相关性采用Pearson相关系数。结果:与麻醉诱导后15 min (T1)相比,气腹后30 min (T2)平均ONSD有显著变化(P < 0.001),平均增加0.04cm(0.57±0.06比0.61±0.06)。气腹后30 min, ONSD变化与EtCO2变化呈正相关(相关系数= 0.629,P = 0.001)。ONSD变化与体位变化相关性较弱(相关系数= 0.276),ONSD变化与IAP变化相关性极弱(相关系数= 0.19)。结论:根据ONSD测量,儿童腹腔镜手术可导致ICP显著增加;EtCO2的变化是主要因素。增加分分钟通气以维持正常的EtCO2可能有助于减轻腹腔镜手术儿童ICP的变化。
Ultrasonographic measurement of optic nerve sheath diameter during laparoscopic surgeries in pediatric patients: An observational study.
Background and aims: Laparoscopic surgery involves creation of carbondioxide (CO2) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed to study the magnitude of changes in ONSD occurring during pediatric laparoscopic surgery and correlate them with changes in end-tidal CO2 (EtCO2), intrabdominal pressure (IAP), and a change in patient position (P).
Material and methods: Thirty-five pediatric patients between 1 and 12 years undergoing laparoscopic surgeries under general anesthesia were included.The ONSD, EtCO2, IAP, and position (P) in degrees from supine were recorded 15 min post-anesthesia induction(T1) and 30 min following the establishment of pneumoperitoneum (T2).The difference between the two groups was analyzed using a paired or unpaired t-test for quantitative variables and using Chi-square or Fisher's exact test for qualitative data.Correlation between two quantitative variables was performed using Pearson's correlation coefficient.
Results: Mean ONSD showed a significant change (P < 0.001) 30 min (T2) following pneumoperitoneum increasing by an average of 0.04cm as compared to 15 min (T1) post-anesthesia induction (0.57 ± 0.06 vs. 0.61 ± 0.06). There was a moderate to strong positive correlation between change in ONSD and change in EtCO2(correlation coefficient = 0.629, P = 0.001) 30 min post pneumoperitoneum. There was a weak correlation between change in ONSD and change in position (correlation coefficient = 0.276) and a very weak correlation between change in ONSD and change in IAP (correlation coefficient = 0.19).
Conclusions: Laparoscopic surgeries in children can cause significant increases in ICP as measured by the ONSD; changes in EtCO2 are the predominant factor responsible. Increasing minute ventilation to maintain normal EtCO2 may help mitigate changes in ICP in children undergoing laparoscopic surgery.
期刊介绍:
The JOACP publishes original peer-reviewed research and clinical work in all branches of anaesthesiology, pain, critical care and perioperative medicine including the application to basic sciences. In addition, the journal publishes review articles, special articles, brief communications/reports, case reports, and reports of new equipment, letters to editor, book reviews and obituaries. It is international in scope and comprehensive in coverage.